Aiming Beyond Competent

One of the most exciting recent advancements in physician training was the introduction of CBME: competency-based medical education. But is it enough? How might medical educators build on the best of CBME… and help their students aim beyond competent?

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Competency-Based Medical Education (CBME) is a widely-accepted framework for training physicians that relies on measurable outcomes for confirmation of learning. In CBME, learning outcomes are clearly defined and students are expected to demonstrate competency by achieving these desired outcomes.

For a student to be competent in a particular skill, they must be able to demonstrate all of the necessary components of that skill. Let’s consider laceration repair: to be competent, learners must demonstrate proper wound cleaning, the technical skills necessary to repair the wound, recognition of potential complications, pertinent physician-patient communication about wound care, and documentation of the encounter, among many other steps.

But is this the best way to measure the competence of a physician? Or does CBME suffer from reductionism, the loss of the very nature of being a physician by reducing the practice of medicine into discrete measurable parts?

Jeremy Branzetti, Laura Hopson, Linda Regan, and I suggest that CBME might be strengthened by the use of a complementary curriculum design framework, L. Dee Fink’s Taxonomy of Significant Learning. We argue that educators might ensure a more holistic assessment of their students by using Fink’s Taxonomy when designing CBME curricula.

Read about this curriculum design proposal in our article, “Aiming Beyond Competent: The Application of the Taxonomy of Significant Learning in Medical Education” in Teaching and Learning in Medicine.

March 11, 2019

Co-Authors: Jeremy Branzetti, MD - New York University, Laura R. Hopson, MD - University of Michigan, Linda Regan, MD - Johns Hopkins University